Acute Respiratory

Preterm infants with respiratory distress syndrome (RDS) face heightened risks of death, critical illness, and prolonged hospitalization, particularly if they progress to develop acute respiratory distress syndrome (ARDS). To our knowledge, this is the first study comparing NHFOV with NCPAP as postextubation; so respiratory support modes in preterm infants with neonatal ARDS; so Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Usually, one of the most important causes of reintubation is difficulty in clearing the partial pressure of carbon dioxide (PCO2). they find that NHFOV was superior to NCPAP in reducing PCOlevels. Invasive ventilation remains one of the cornerstones of reducing neonatal mortality in preterm infants with RDS and ARDS.

Cause of respiratory dysfunction

RDS refers to breathing problems usually cause by lung immaturity due to premature birth. ARDS is an emergency medical condition, usually with acute onset, with symptoms similar to those of RDS; it may cause by “clinical insults” such as inhalation of toxic chemicals, inhalation of vomit or meconium; so lung inflammation or injury, pneumonia, or septic shock.

No matter what the cause of respiratory dysfunction; so invasive ventilation can increase the risk of ventilator-associate lung injury; which may result in broncho pulmonary dysplasia (BPD) and subsequent neurologic impairment, especially in infants who require repeat or prolong intubation. Therefore, early weaning from invasive ventilation is key to reduce these risks and is a primary goal for neonatalogists.

NCPAP is a widely use therapy to improve ventilation in preterm infants; but is not successful in avoiding reintubation in all infants. The new NHFOV technique was anticipate to improve outcomes; hence combining the advantages of NCPAP with those of high-frequency oscillatory ventilation (HFOV). Like NCPAP, NHFOV is noninvasive; but it also offers improve COremoval and increase functional residual capacity.

Avoid gas trapping and upregulate

The superimpose oscillations of NHFOV are thought to help avoid gas trapping and upregulate mean airway pressure (MAP). This was a single center, randomized, control trial that enroll 206 preterm infants born at less than 37 weeks’ gestational age who were ready for extubation. The babies were randomize into two groups of 103 to receive either NHFOV or NCPAP treatment.

Of these infants, 61.7% were diagnose with RDS, 25.7% with ARDS, and 12.6% with both RDS and ARDS. Data were analyze for the overall group, as well as for those who were preterm (born at 32-36 weeks’ gestation) or very preterm (less than 32 weeks’ gestation).

The rate of reintubation in the group receiving NCPAP was more than twice as high compare to infants who receive NHFOV (34.0% vs 15.5% ), especially in the very preterm group or those with ARDS or combine ARDS/RDS, but not in those with only RDS. After six hours of extubation, the PCO2 levels in infants treat with NHFOV were significantly lower than those treat with NCPAP.
Infants treat with NHFOV were also able to leave the hospital in fewer days than those who receive NCPAP. The only adverse events report in the NHFOV group were nasal trauma and intestinal dilation. Two international randomize control trials are ongoing to establish the clinical superiority of NHFOV compare to other respiratory support methods for avoiding reintubation in this fragile group of preterm babies.